Comparative Assessment of Chemotherapy Followed by Consolidative Radical Cystectomy Versus Chemoradiation for Clinically Node-Positive Urothelial Carcinoma of the Bladder
Ślusarczyk, Aleksander (Medical University of Warsaw)
Contieri, Roberto (Istituto Nazionale Tumori di Napoli IRCCS Fondazione "G. Pascale")
Longoni, Mattia (IRCCS Ospedale San Raffaele)
Miszczyk, Marcin (WSB University)
Krajewski, Wojciech (Wrocław Medical University)
Laukhtina, Ekaterina (Medical University of Vienna)
Del Giudice, Francesco (Umberto I Polyclinic Hospital)
Gallioli, Andrea (Institut de Recerca Sant Pau)
Pradere, Benjamin (La Croix Du Sud Hospital)
Boorjian, Stephen A. (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Moschini, Marco (IRCCS Ospedale San Raffaele)
Scilipoti, Pietro (IRCCS Ospedale San Raffaele)
Angelis, Mario De (IRCCS Ospedale San Raffaele)
Rajwa, Pawel (Centre of Postgraduate Medical Education)
Shah, Paras (Mayo Clinic)
Radziszewski, Piotr (Medical University of Warsaw (Polònia))
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2025
Resum:	Context: Patients with bladder cancer and clinically positive pelvic lymph nodes (cN+) have poor prognosis, and the optimal definitive treatment method remains controversial. Objective: To compare survival outcomes between chemotherapy followed by radical cystectomy (RC) and chemoradiation (CRT) in patients with cN+ bladder cancer. Methods: We queried the Surveillance, Epidemiology, and End Results (2000-2021) database to identify patients with cN+ bladder cancer treated with CRT or chemotherapy and RC. Cumulative incidence functions, Fine-Gray model, and Cox proportional hazards were used for the survival analysis. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. The primary endpoints were cancer-specific mortality (CSM) and all-cause mortality (ACM). Results: Among 552 patients identified, 175 (32%) received CRT and 377 (68%) underwent chemotherapy plus RC, and 5-year ACM was 75% (95% confidence interval [CI]: 71%-78%). RC and CRT were associated with 5-year CSM of 62% (95% CI: 57%-67%) and 72% (95% CI: 65%-78%), and 5-year ACM of 70% (95% CI: 65%-75%) and 85% (95% CI: 75%-90%), respectively. After IPTW, on multivariable Cox proportional hazard analysis adjusted for nodal and tumor staging, age, gender, tumor size and race, RC was associated with a significantly lower risk of CSM (hazard ratio [HR]: 0. 47, 95% CI: 0. 37-0. 60, P <. 001) and ACM (HR: 0. 53, 95% CI: 0. 46-0. 60, P <. 001). Conclusions: Patients with cN+ bladder cancer who received CRT had a worse prognosis compared to those who underwent chemotherapy followed by RC. The incorporation of more effective systemic therapies is required to improve outcomes, as in our analysis, only one in four cN+ patients survived beyond 5 years.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Chemoradiation ; Clinically-positive lymph nodes ; Radical cystectomy ; Survival ; Urinary bladder neoplasms ; Urothelial carcinoma
Publicat a:	Clinical Genitourinary Cancer, Vol. 23, Num. 5 (October 2025) , art. 102399, ISSN 1938-0682

DOI: 10.1016/j.clgc.2025.102399
PMID: 40737768

10 p, 1.0 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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